Painkiller junkies unaware of options

Abuse of prescription painkillers can lead to overdose, and while safe and effective interventions are available, most narcotic abusers are unaware of their options.

Although teens and young adults who abuse prescription painkillers face a high risk of overdose, most don't know how to respond when one occurs, new research shows.

Sometimes leading to death

At issue is the increasingly popular, non-medicinal use of legal prescription narcotic pain medications, including so-called "opioids" such as Oxycontin and Vicodin.

Such drugs can substantially slow or even halt the ability to breathe, sometimes leading to death. And while safe and effective interventions are available (including the prescription medication naloxone), the new study found that most narcotic abusers are unaware of their options.

"What we found is that when it comes to how to handle an overdose, prescription opioid users who weren't using drugs for official medical reasons were less savvy than, say, more traditional heroin-using populations," said study author David Frank, a doctoral candidate in the department of sociology at the CUNY Graduate Centre in New York City.

"In fact, they tend to have a pretty severe lack of knowledge and a lot of confusion about it, despite the fact that most have experienced overdoses within their drug-using network," said Frank.

Why?

"We found that prescription opioid [users] make a big distinction between themselves and heroin users," Frank said. "Opioid users tend to be whiter, younger and come from a higher socioeconomic background. And even though opiates and heroin are pharmacologically similar, work by the same mechanism and can both cause an overdose, even daily opioid users seem to think that simply because they're taking a doctor-prescribed medicine they're not doing a dangerous drug."

Social stigma

An expert at the U.S. National Institute on Drug Abuse (NIDA) agreed. "Stigma lies at the heart of the problems highlighted in this article," said Jack Stein, director of the office of science policy and communications at the NIDA.

"Societal stigma against heroin abuse and associated ignorance about heroin addiction has prevented those who become addicted to prescription opioids from recognizing their abuse as similar to, and equally dangerous as, heroin abuse," Stein said.

"Thus, information about safety and overdose prevention and available treatments, including naloxone and buprenorphine, fail to reach this new opioid-addicted demographic," Stein explained. "This same stigma has prevented health care providers from recognizing the signs of prescription opioid abuse or knowing how to manage addiction in their patients who may not fit the expected profile or stereotype of a drug abuser."

NIDA estimates from 2010 suggest that in excess of 5 million Americans now abuse prescription pain medication, with roughly one in 12 high school seniors abusing the narcotic Vicodin, and one in 20 abusing Oxycontin.

To gauge the level of overdose knowledge among prescription painkiller abusers, the study authors conducted in-depth interviews among 46 users aged 18 to 32. All were residents of New York City, where the number of opioid-related overdose deaths tripled between 2000 and 2011, according to background information in the study.

Perceived as relatively harmless

Nearly three-quarters of the participants were white. Half of the group had at least some college education. Nine were college graduates.

The investigators found that prescription painkillers were initially perceived as relatively harmless "medications" that were less addictive than heroin, and less likely to prompt an overdose.

But, nearly all of those interviewed said they knew someone who had experienced a fatal or nonfatal overdose, or had experienced an overdose themselves. Yet the majority said that they were unaware of overdose prevention or response options, including naloxone.

Even among those familiar with naloxone, there was a common belief that it was expensive or hard to get. However, in New York state, naloxone is distributed freely (with training) at most official needle-exchange or harm reduction programmes, the study authors said.

Still, the majority of participants (29) said they had never sought out any such programme or organisation.

Outreach programmes

Many said that such facilities tended to place too much focus on heroin use, an emphasis that conflicted with their general perception that using prescription narcotics is wholly distinct from using "street" heroin.

The researchers concluded that to tackle overdose risk among prescription narcotics abusers, there is a "pressing need" to fashion outreach programmes that better address their unique concerns and perceptions.

"Solutions are tough," Frank acknowledged. "I would say that it's important to expand access to naloxone and information about naloxone. And to do that by focusing more on getting prescription drug users to access harm reduction programmes more frequently, because to a certain extent these programmes may have been a little behind the curve on reaching out to this subculture," he said.

"But more generally, I also think a part of it is about reaching out to young people in high schools and colleges, because we know that prescription opioid use often starts in high school. But often high schools and colleges emphasise abstinence and won't talk about something like naloxone because they think it's going to encourage drug use," Frank added. "But I think a more harm-reduction minded way of approaching the problem would be helpful."

Frank and his colleagues published their findings in a recent issue of the International Journal of Drug Policy.

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